Closing the Health Care Gap

Ron Williams, Aetna Chairman, CEO and President: The whole issue of racial and ethnic disparities is really about empowering the member and making sure the plan sponsor is receiving value for the premium that they pay.

Cheryl Pegus, MD, Aetna Clinical Product Head: And Aetna has definitely taken a lead, because we're saying this is not something people are wondering - we have data to support that there are differences. So now how do we work towards solutions? It's not a blame game. It's 'how do we work towards a solution'.

Sampson Davis, MD: Hi, we're The Three Doctors. We've made it our mission, as a team, to create opportunities for communities through education, mentoring and health awareness.

Rameck Hunt, MD: As African American students coming from the inner cities, the three of us were determined to rise above any hardships and avoid becoming victims of our surroundings, so, 15 years ago, we made a pact to go to college and become doctors, dedicating our lives to medicine, and now we're working to inspire and teach children and adults from all communities that they can live fulfilling, healthy lives.

George Jenkins, DMD: As African American students coming from the inner cities, the three of us were determined to rise above any hardships and avoid becoming victims of our surroundings, so, 15 years ago, we made a pact to go to college and become doctors, dedicating our lives to medicine, and now we're working to inspire and teach children and adults from all communities that they can live fulfilling, healthy lives.

Joe Betancourt, MD, MPH.: Aetna, I think, has been one of the industry leaders in this area. Aetna's leadership has been primarily around saying and acknowledging that disparities are real and that there is a problem and that they, as a health plan, feel that it's critical that they do something about it.

R. Williams: And for the employer who's providing health insurance and for the health plan who's really trying to facilitate access to that health care, it will mean that we need to really understand those cultures, those racial groups and those ethnicities so that we can, in fact, develop health care delivery systems and information support to really help people get the most value from their health care.

John W. Rowe, MD, Aetna Former Executive Chairman: To be specific about these disparities, one of the very important ones has to do with the much greater risk for African American women of having low birth-weight infants.

Eileen Yozallinas, RNC, MS, Aetna Care Management Nurse Manager: In all births in the U.S., about 12% are preterm births. In the African American community, 17.6% of their births are preterm. So you can see there is a disparity that really needs to be looked at. Some of it has to do with late prenatal care.

Monique Wilson (patient): Before entering into the Moms to Babies program, I really knew nothing about preterm labor and the causes of preterm labor, and since I've been a part of Moms to Babies, it's been extremely informative. I've learned everything I know.

Yozallinas: Every African American woman in our program is considered high risk and is...there is outreach by a case manager.

In Moms to Babies we, to really assure quality of care, we use two home care agencies that actually do our preterm labor education program. Basically, this is a visit by an obstetrically trained nurse, and that's really important, so that she can answer all the questions about the fetus.

Nurse: If you're having a contraction, then this will get all firm, all the way across.

Patient: Oh, the entire thing?

Nurse: Uh huh, the entire thing.

Troyen Brennan, MD, Aetna Chief Medical Officer: Health care plans can do a great deal about racial and ethnic disparities in health care. But they didn't always concede that that was their responsibility. In fact, it wasn't until Aetna took a leadership role in this area that we began to realize exactly what health plans could do.

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Targeted Solutions

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Dr. Hunt: The issue of health care disparities is immensely complex, but there are targeted solutions that can help us bridge the gap.

Dr. Jenkins: One of these solutions is improving communication between doctors and patients, so that cultural and language barriers are eliminated.

Gregory G. Williams (patient): I think it is the approach, you know? I think doctors, some doctors can relax you. The way he greets you out, it's like a friend... With Dr. Betancourt, you come and he's relaxed, you know, he shakes your hand, and it's beautiful.

Dr. Betancourt: Alright! How are you? Good to see you.

B. Waine Kong, PhD, JD: Every physician and every health care provider needs to have some cultural sensitivity training and be able to respond to people in a way that will make them want to cooperate more.

Dr. Brennan: Another good example of how a health plan like Aetna can step up to the plate is with regard to its own employees. We have hundreds of nurses and scores of doctors who reach out to patients. We wanted to assure ourselves that those interactions were culturally competent ones. As a result, we've had over 95% of our clinicians undergo a training program, designed by Joseph Betancourt.

Dr. Betancourt: So we developed an e-learning program: a 2-hour, computer-based, web-based interactive program with patient cases so you, as a health care provider, you log on and you actually have to see three patients and, through that, we begin to teach you how you might take different things into consideration, how you might use simple language, how you might negotiate with patients, all towards getting a better outcome and addressing disparities.

Dr. Brennan: We believe that this is going to provide real value for our members, especially since there's very little training in American medical school today on cultural competence. We're taking a significant step.

Linda Mako, RN, Aetna Supervisor: When we speak with any member, we really want to get an appreciation for where they're coming from and their background.

Dr. Betancourt's training really helped hone my skills as far as teaching people how to communicate in the best way over the phone in order to ask those open-ended questions, in order to understand what's going on with each member individually.

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Patient Tools & Information

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Dr. Davis: We strongly believe that communication and education, when sensitive to cultural differences, can inspire people to take control of their health.

Dr. Jenkins: We need to educate people of all backgrounds about the importance of healthy lifestyle, timely screenings, and medication adherence.

Dr. Hunt: To make sure that everyone understands all of these aspects of their treatment, we need programs that offer people tools and information to better manage their health conditions.

Dr. David Satcher, MD, PhD (former U.S. Surgeon General): I think the relationship between Aetna and Morehouse has been a very important relationship. Aetna has supported some very important programs here dealing with diabetes management.

Mike Leavitt, Secretary of the U.S. Department of Health & Human Services: About a year ago, the Agency for Healthcare Research and Quality launched a collaborative effort with 10 of the nation's largest health care insurance plans to help disparities among people with diabetes and other conditions. I'd like to recognize Jack Rowe, the CEO of Aetna, for the leadership that he has shown in the development of this partnership.

Dr. Rowe: Another area that is particularly relevant to Latinos as well as to African Americans is the area of diabetes. Diabetes is more prevalent in these populations, and we find in our population of insured people that some of the usual preventive measures, such as the screening for hemoglobin A1C or for visual exams or foot exams and other kinds of routine screening that is recommended for the maintenance of individuals with diabetes, that occurs much less frequently in these racial and ethnic minority diabetics than it does in Caucasian diabetics.

Judy Langley, RN, Aetna Director, National Quality Management: We've also researched in regards to the Hispanic/Latino population, what motivates them to take action and take care of their condition, and it's mostly prompted by what the physician instructs them to do. So with that in mind, we've developed a Diabetes Cultural Diversity Kit focused on the Hispanic/Latino population.

Dr. Satcher: We've looked at diabetes from several perspectives, and this effort has been funded by Aetna over the last few years. But we've especially been concerned with the quality of care that people with diabetes get, so this collaboration has been a collaboration in which we've been working together to try and improve the quality of care.

Dr. Davis: Through this kind of collaboration, new programs and tools are created to help manage the health needs of diverse populations.

Dr. Satcher: This program of improving the quality of diabetes management has really taken on a new level of emphasis throughout the state of Georgia, and that is: can we make sure that by using the most recent technology in the management of diabetes, everybody, regardless of race or ethnicity, gets the same quality of care? So this diabetes management program that Aetna has supported here is evolving into something that could really be big throughout the state of Georgia and, ultimately, the nation.

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Reaching Out To Minorities

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Kong: African Americans have 50% more hypertension than anyone else. When we're diagnosed and we get into treatment we're less likely to get it under control. So now we're looking at only 30 % of African Americans who have high blood pressure now have it under control. Now this is a very dangerous condition that needs to be paid attention to because if you don't, then there's a natural progression towards heart failure and heart attacks and, particularly, strokes.

Dr. Pegus: And so what we're doing at Aetna is we're reaching out to our African American members who are enrolled in our Disease Management programs, and letting them know that 1) high blood pressure is a serious medical condition, even though you may not feel any symptoms from high blood pressure, it can lead to early stroke, and it will lead to the development of heart disease. Part of what we're doing in our program is making sure that they're aware of how to take care of themselves. And so we're providing home kits, of blood pressure kits, so that people can monitor their own blood pressures at home; we're making sure we're helping in how high blood pressure can be treated.

Audrietta Izlar (Verizon): When we look at our overall health care spend at Verizon, our top health conditions are diabetes, hypertension, high cholesterol, coronary artery disease, breast cancer- all of which we know have a higher prevalence in minority populations. They're at greater risk.

R. Williams: I believe that one of the ways Aetna has differentiated itself is really by focusing on problems that are very important problems to our members and very important problems to our plan sponsors who pay the premiums.

Dr. Betancourt: I think Aetna has set themselves apart as one of the industry leaders and, as such, they have a lot of people around the country looking at them and looking at their next steps, and I think it's really incumbent upon them to continue to be creative, to continue to be cutting-edge both around the education they provide internally and to their providers, around the initiatives they focus on for their employers who they work with, their efforts for educating their members.

Dr. Brennan: There's much more that can be done about racial and ethnic disparities in health care. We suggest that people take the approach that Aetna is taking. And that's really two things: One is to apply what we already know around cultural competency and health literacy, for example. The second is to continue to study the problem, identify exactly what the barriers are, address that through programs that can improve care, and then re-study to see whether we've made any difference. We at Aetna are committed to that for the health of our members.

R. Williams: Racial and ethnic disparities is an extremely important problem and if we look at the composition of the workforce, which will be more than 41% minorities and people of color by 2008, it's a very important problem, and solving it can pay big dividends for our members as well as for plan sponsors.

Izlar: We cover about 250,000 employees; 33% of our employees are minorities. And so it's important, as a plan sponsor who spends about 3 billion dollars on health care, that we get the biggest bang for our buck.

Dr. Jenkins: Aetna has made an important commitment to tackling the problem of ethnic and cultural disparities in health care, and continues to strive towards improving the quality of care for people of all backgrounds.

Dr. Hunt: Through education and awareness of our cultural differences, and health care that takes these differences into account, we are all inspired to close the gap.